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炎症性肠病:临床诊断与药物治疗

Inflammatory Bowel Disease: Clinical Diagnosis and Pharmaceutical Management.

作者信息

M'Koma Amosy Ephreim

机构信息

Department of Biochemistry, Cancer Biology, Neuroscience and Pharmacology, Meharry Medical College School of Medicine, Nashville, Tennessee, United States.

Department of Pathology, Anatomy and Cell Biology, Meharry Medical College School of Medicine, Nashville General Hospital, Nashville, Tennessee, United States.

出版信息

Med Res Arch. 2023 Jan;11(1). doi: 10.18103/mra.v11i1.3135. Epub 2023 Jan 31.

Abstract

Inflammatory bowel disease has an enormous impact on public health, medical systems, economies, and social conditions. Biologic therapy has ameliorated the treatment and clinical course of patients with inflammatory bowel disease. The efficacy and safety profiles of currently available therapies are still less that optimal in numerous ways, highlighting the requirement for new therapeutic targets. A bunch of new drug studies are underway in inflammatory bowel disease with promising results. This is an outlined guideline of clinical diagnosis and pharmaceutical therapy of inflammatory bowel disease. Outline delineates the overall recommendations on the modern principles of desirable practice to bolster the adoption of best implementations and exploration as well as inflammatory bowel disease patient, gastroenterologist, and other healthcare provider education. Inflammatory bowel disease encompasses Crohn's disease and ulcerative colitis, the two unsolved medical inflammatory bowel disease-subtypes condition with no drug for cure. The signs and symptoms on first presentation relate to the anatomical localization and severity of the disease and less with the resulting diagnosis that can clinically and histologically be non-definitive to interpret and establish criteria, specifically in colonic inflammatory bowel disease when the establishment is inconclusive is classified as indeterminate colitis. Conservative pharmaceuticals and accessible avenues do not depend on the disease phenotype. The first line management is to manage symptoms and stabilize active disease; at the same time maintenance therapy is indicated. Nutrition and diet do not play a primary therapeutic role but is warranted as supportive care. There is need of special guideline that explore solution of groundwork gap in terms of access limitations to inflammatory bowel disease care, particularly in developing countries and the irregular representation of socioeconomic stratification with a strategic plan, for the unanswered questions and perspective for the future, especially during the surfaced global COVID-19 pandemic caused by coronavirus SARS-CoV2 impacting on both the patient's psychological functioning and endoscopy services. Establishment of a global registry system and accumulated experiences have led to consensus for inflammatory bowel disease management under the COVID-19 pandemic. Painstakingly, the pandemic has influenced medical care systems for these patients. I briefly herein viewpoint summarize among other updates the telemedicine roles during the pandemic and how operationally inflammatory bowel disease centers managed patients and ensured quality of care. In conclusion: inflammatory bowel disease has become a global emergent disease. Serious medical errors are public health problem observed in developing nations i.e., to distinguish inflammatory bowel disease and infectious and parasitic diseases. Refractory inflammatory bowel disease is a still significant challenge in the management of patients with Crohn's disease and ulcerative colitis. There are gaps in knowledge and future research directions on the recent newly registered pharmaceuticals. The main clinical outcomes for inflammatory bowel disease were maintained during the COVID-19 pandemic period.

摘要

炎症性肠病对公众健康、医疗系统、经济和社会状况产生了巨大影响。生物疗法改善了炎症性肠病患者的治疗和临床病程。目前可用疗法的疗效和安全性在许多方面仍不尽如人意,凸显了对新治疗靶点的需求。一系列针对炎症性肠病的新药研究正在进行中,且取得了有前景的结果。这是一份炎症性肠病临床诊断和药物治疗的概述指南。概述阐述了关于理想实践现代原则的总体建议,以促进最佳实施方案的采用、探索以及对炎症性肠病患者、胃肠病学家和其他医疗服务提供者的教育。炎症性肠病包括克罗恩病和溃疡性结肠炎,这两种未解决的医学炎症性肠病亚型尚无治愈药物。首次出现的体征和症状与疾病的解剖定位和严重程度有关,而与最终诊断的关系较小,因为在临床和组织学上可能难以明确解释和确立标准,特别是在结肠炎症性肠病中,当诊断不明确时会被归类为不确定性结肠炎。保守药物和可及途径并不取决于疾病表型。一线治疗是控制症状并稳定活动性疾病;同时需要进行维持治疗。营养和饮食并不起主要治疗作用,但作为支持性护理是必要的。需要有专门的指南来探索解决炎症性肠病护理获取限制方面的基础差距问题,特别是在发展中国家,以及社会经济分层的不均衡情况,并制定战略计划,以解决未解决的问题和展望未来,尤其是在由冠状病毒SARS-CoV2引发的全球COVID-19大流行期间,这对患者的心理功能和内镜检查服务都产生了影响。全球登记系统的建立和积累的经验促成了在COVID-19大流行期间对炎症性肠病管理的共识。令人痛心的是,大流行对这些患者的医疗系统产生了影响。在此我简要总结观点,包括大流行期间远程医疗的作用以及炎症性肠病中心在运营上如何管理患者并确保护理质量等其他更新内容。总之:炎症性肠病已成为一种全球紧急疾病。在发展中国家存在严重的医疗错误这一公共卫生问题,即区分炎症性肠病与感染性和寄生虫性疾病。难治性炎症性肠病在克罗恩病和溃疡性结肠炎患者的管理中仍然是一个重大挑战。关于最近新注册药物存在知识差距和未来研究方向。在COVID-19大流行期间,炎症性肠病的主要临床结局得以维持。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6f75/10118064/fdb356379e05/nihms-1873821-f0001.jpg

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